目的 探讨两种不同类型肺隔离症(pulmonary sequestration,PS)患儿的临床特点、血供分布、治疗及预后,提高对PS的认识和临床诊治水平.方法 回顾性研究自2005年1月至2017年10月期间收治的隔离肺患儿,总计纳入研究208例,其中男138例,女70例.年龄1个月～14岁,平均(19.7±48.82)个月.总结分析208例隔离肺病例的临床资料,手术方法,手术效果及预后.术前通过增强CT确诊分为叶内、叶外型及两者并存.通过增强CT对隔离肺动静脉血供进行分析,动脉血供主要来自胸主动脉或腹主动脉,静脉回流主要肺静脉、奇静脉.结果 手术时间10～230 min,平均(70±48.75) min,出血量1～200ml,平均(5±18) ml.叶内型PS 143例,叶内叶外共存3例共146例病例,肺叶切除112例,楔形肺段切除34例.叶外型PS 62例,均行病变肺组织切除.对叶内型与叶外型临床资料分析比较,发现叶内型明显多于叶外型而男女分布比例无明显差异.叶内型PS伴临床症状者明显多于叶外型PS患儿,两者差异有统计学意义.二者体循环血供多源于主动脉供血,两者差异有统计学意义,叶外型PS病变部位分布变异多,动脉供血更为复杂.静脉回流叶内型多回流于肺静脉,而叶外型多回流于奇静脉、半奇静脉,两者差异有统计学意义.腔镜手术并发症发生率两者差异无统计学意义.结论 隔离肺越来越多经产前B型超声检查发现,增强CT和核磁共振是诊断隔离肺的主要手段.叶内外型隔离肺在病变部位和血管分布上存在明显不同.%Objective To summarize the clinical outcomes and differences for two subtypes of pulmonary sequestration (PS).Methods We retrospectively reviewed 208 patients undergoing surgery for PS at our institution between 2005 and 2017.There were 138 boys and 70 girls.All of them were operated successfully without surgical mortality and their etiologies pathologically confirmed postoperatively.They were divided into three types of intralobar sequestration,extralobar sequestration and bilateral sequestrations according to preoperative scans of enhanced computed tomography.The mean age was 19.7 ± 48.82 (1/12-168) months.Demographic profiles,surgical approaches,preoperative symptoms and complications were collected from medical records.Results The mean operative duration was (70 ± 48.75) (10-230) min and the mean volume of blood loss (5 ± 18) (1-200) ml.Arterial supply was predominantly provided by branches of thoracic or abdominal aorta.The veins of sequestration were drained into pulmonary,azygos and hemizygos veins.Among 143 intralobar sequestrations and 3 bilateral sequestrations,lobectomy (n =112) and segmental lobectomy (n =34) were performed.All cases of extralobar sequestration underwent lesional lobectomy.Statistically significant differences existed in venous return,symptomatic and lesion sites between patients with intraplantar and extralobar PS.Conclusions PS patients may be detected by preterm ultrasonography.The most useful diagnostic methods for pulmonary sequestration are CT angiography (CTA) and magnetic resonance imaging (MRI).Significant distinctions exist in lesion region,arterial supply and venous drainage between different types of pulmonary sequestrations.
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